- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.63 / $1,745.81 / $2,905.25
| Facility | | $561.63 | $1,745.81 | $2,905.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $561.63 / $683.15
| Professional | | $455.43 | $561.63 | $683.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.83 / $1,320.75 / $3,605.49
| Facility | | $560.83 | $1,320.75 | $3,605.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $759.05 / $2,850.26
| Professional | | $455.43 | $759.05 | $2,850.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.38 / $1,725.12 / $3,015.95
| Facility | | $1,206.38 | $1,725.12 | $3,015.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.00 / $645.00 / $751.46
| Professional | | $645.00 | $645.00 | $751.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.38 / $605.21 / $1,726.83
| Facility | | $493.38 | $605.21 | $1,726.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.53 / $728.71 / $1,978.41
| Professional | | $379.53 | $728.71 | $1,978.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,504.00 / $9,239.00
| Facility | | $83.43 | $3,504.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.45 / $1,095.45 / $1,288.77
| Professional | | $1,095.45 | $1,095.45 | $1,288.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $2,350.69
| Professional | | $759.05 | $759.05 | $2,350.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.75 / $3,605.49 / $3,605.49
| Facility | | $1,320.75 | $3,605.49 | $3,605.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.57 / $481.40 / $3,795.25
| Professional | | $341.57 | $481.40 | $3,795.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $481.40 / $1,458.14
| Professional | | $318.80 | $481.40 | $1,458.14 |